Appeals Pharmacist (Remote)

Key Responsibilities: Review clinical documentation for medication coverage appeals and grievances. Apply plan policies, evidence-based guidelines, and regulatory requirements to reach determinations. Prepare clear written clinical rationales supporting appeal outcomes. Collaborate with physicians, nurses, and medical directors during case reviews. Track and report appeal outcomes in full compliance with state and federal rules. Contribute to process improvements that enhance timeliness and quality. What You'll Bring

Education: PharmD or Bachelor of Pharmacy.

Licensure: Active U.S. pharmacist license.

Experience: Managed care or utilization management preferred. Hospital, ambulatory, and community pharmacists with strong documentation and clinical skills are encouraged to apply.

Skills: Excellent clinical judgment, written communication, and regulatory attention to detail. Why This Role? Fully remote or hybrid options available. Play a critical role in ensuring patients receive fair access to necessary medications. Build expertise in appeals, utilization management, and managed care. Competitive salary, comprehensive benefits, and advancement paths.

About Us: We are a confidential healthcare partner working with health plans and managed-care organizations nationwide. Our appeals pharmacists protect patient access while upholding regulatory standards. Apply TodayJoin our team as a Remote Appeals Pharmacist and help ensure every member receives a fair, evidence-based review.